Complete Story

12/22/2016

CMS Advances National Prior Authorization for DME!

Source: MiraVista

Nearly a full year after CMS published its final rule on prior authorization for general DMEPOS along with a master list of 135 items potentially subject to authorization, the process is beginning to take shape. As MiraVista predicted last February, the initial implementation is very limited.

CMS announced the national prior authorization rollout on Monday, December 19 for two HCPCS codes:

K0856: Power wheelchair, group 3 std., single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds

K0861: Power wheelchair, group 3 std., multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds

The rollout will take place in two phases. Beginning March 19, 2017, CMS will initiate a targeted rollout to suppliers in the following four states (one in each DME MAC Jurisdiction):

New York (JA),

Illinois (JB),

West Virginia (JC), and

Missouri (JD)

On July 17, 2017, CMS expects to implement prior authorization for these codes nationwide.

But this advancement is MUCH bigger than the first two codes. This is a welcome innovation that HMEs can get behind, and it will soon be available to ALL suppliers. MiraVista projects that CMS will deploy a much more meaningful expansion for 2018.

Please join us on January 31, 2017 as we host a special online forum to discuss the benefits and requirements of the authorization program, prepare for the concrete elements of the mandate, and contemplate the necessity of direct practitioner involvement as implementation guidance is being shaped.